Introduction: The rapid expansion of endovascular neurosurgery has resulted in an increased number of specialists trained in both open microsurgery and endovascular techniques. We hypothesized that hybrid cerebrovascular neurosurgeons (HCNs) would select different subsets of aneurysms for open surgery as compared to neurosurgeons with traditional microsurgical training (TCN).
Methods: A prospective, single-center database of all cerebral aneurysms treated at a single institution was retrospectively reviewed to identify all cerebral aneurysms treated with open surgery from 2007 to 2012. All surgeries were performed by either one of four TCNs or, starting in July 2010, by one HCN. Differences in aneurysm locations were analyzed using Fischer’s exact test.
Results: The number of elective, unruptured surgical aneurysm cases by TCNs and the HCN were 252 and 58, respectively. 95.2% of the unruptured aneurysms treated by TCNs were anterior circulation as compared to 98.3% for the HCN (p=0.47). The distribution of elective anterior circulation aneurysms was internal carotid artery (ICA) 42.1% TCN vs. 25.9% HCN (p=0.03), middle cerebral artery (MCA) 31% TCN vs. 39.7% HCN (p=0.22), and anterior communicating artery (ACOM) 19% TCN vs. 31% HCN (p 0.05). The number of ruptured aneurysm case by TCNs and the HCN were 151 and 17, respectively. 96.7% of the ruptured aneurysms treated by TCNs were anterior circulation compared to 89.9% for the HCN (p=0.16). The distribution of ruptured aneurysms in the anterior circulation was ICA 36.4% TCN vs. 22.2% HCN (p=0.3), MCA 21.1% TCN vs. 16.7% HCN (p=1.0), and ACOM 33% TCN vs. 50% HCN (p=0.19).
Conclusions: There is a statistically significant difference in the location of anterior circulation aneurysms selected for elective open surgery by the HCN compared to TCNs. The HCN treated a smaller percentage of ICA aneurysms and a larger percentage of ACOM aneurysms with open surgery.
Patient Care: Understanding potential differences in treatment preferences between traditional cerebrovascular neurosurgeons and hybrid cerebrovascular neurosurgeons in relationship to aneurysm location will be important in the future as endovascular techniques continue to advance and the field continues to evolve in relation to both patient outcome and neurosurgical training.
Learning Objectives: By the conclusion of this session, participants should be able to discuss the importance of analyzing the treatment preferences between traditional cerebrovascular neurosurgeons and hybrid cerebrovascular neurosurgeons in relationship to aneurysm location.